YOUR CART

Clinical Chaplaincy

I paused outside of the room to gather my thoughts and breathe a prayer for the job that was ahead. The hospice nurse had called and informed me of a new patient that had a fast-growing cancer (b cell type lymphoma) on her face, neck, and head. She was not expected to live very long. A month ago she had been 100% healthy, living independently, and had no visible symptoms. The nurse had tried to prepare me for a rather unsightly situation and the considerable difficulty in controlling the pain.

On entering the room, darkened because of the closed drapes and dimmed lights, my eyes slowly adjusted to the darkness. Withering in pain on the bed was a terribly disfigured woman with multiple, open, weeping tumors on her head, of which some were as large as a football; dozens of other tumors ranged in size from a marble to a golf ball. Significant amounts of morphine had been administered sublingually, but had little effect on her pain. Her chart said that she was not a practicing Christian, but had expressed a desire to see the chaplain on admission (some days ago prior to being on hospice). She is elderly, but her body seems to be rather healthy compared to her head. She has a decreased level of consciousness (due to medication and disease) and is alert only to herself, her pain, her end-of-life concerns…

Kim[1] was every bit as bad as can be imagined. She tossed and turned on her bed, her skin was moist and clammy, the sores on her head were… (well, some things can’t be described), and the smell… I pushed up the chair as close to the bed as it would go and sat down. When I took her hand, I could feel the grip tighten around mine (somewhere inside she was still reaching out for community). She whispered a word (one of two words she said while I was there) to me before I could say anything, “Scared!” I told her who I was and did not receive any response other than her hand gripping mine. Her collar-length hair was matted, wet, and hanging in her face. I reached out my other hand and began moving the hair out of her face and running my fingers through her hair and over the tumors that were claiming her life. Her response was almost immediate as she calmed down and began to more comfortably fall asleep. The nurse came in and said, “Thank God you’re here. We haven’t been able to do anything for her.” Amazing what a hand can do when time is given and the effort is made! Over the next few hours I said my prayer, even told the story of how Jesus touched the leper, played some hymns on my iPod, but mostly just held her hand and touched her head and hair. An hour later, her arm relaxed as her coma deepened, and I was able to go. The pager on my phone beeped as I walked down the hall, troubled once again over my last visit. Now the phone was beeping again: a beep that I had learned to associate with crisis. A beep that pulled me from my troubled reflection, “Was I doing enough? Were the songs/scriptures/prayers meaningful? Had I briefly been able to highlight the joined hands of God and man?”

The text message read, “New pt in Cityville, Mo, may die at any moment. Can you come today and do intake/assessment?” A few phone calls later, I had rearranged my schedule, postponed less critical appointments, picked up a lunch for the 160-mile, round-trip journey, and headed down the road in my car to a new unknown crisis. Would I be able to provide comfort? Could I extend the hand of Christ to care for the sick, diseased, and/or demented?

While I drove out to the house, I received a call from the hospice social worker with a briefing on what was known. She was an 82-year-old woman with an inoperable cranial aneurism that could burst at any time. As well, she had an implanted pacemaker/defibrillator that kept firing irregularly whenever the heart failed to fire on its own. She had several children of varying involvement. Finally, she also had some form of dementia.

When I arrived at the house, the front door was ajar, so I walked on in (only done in the country) and found the family room crowded with family and hospice workers trying to provide initial services to the family and client. As is often the case, other than a precursory greeting and/or examination, the demented patient is then ignored and the attention is given to the family. It is the chaplain’s job to ‘spend time’ with the patient (time I love to spend). I knelt next to the wheel chair and put my arm on the back of the chair. The patient immediately gave me a sloppy hug and laid her head on my shoulder. She welcomed me warmly and denied any pain. We talked of her family, of whom she could provide little information to the number or names of her children. She did not know the day, month, or year. She was unable to tell where she was other than “Home!”

​Finally, I asked the questions I am forced to ask about her faith tradition for her records. She immediately stated that she was Catholic. When asked if she had always been Catholic, she stated, “No! I just changed a few weeks ago!” A family member in the background stated, “More like 50 years ago!” When asked what she was before she became Catholic (seeing that it felt so fresh and recent to her) she again answered quickly that she grew up Mormon. When asked if she thought of herself as either Catholic or Mormon, she stated she wasn’t sure. When asked if I could contact a Catholic Priest or Mormon Elder for her, she said, “No! The first one didn’t approve of my first marriage, and the second didn’t approve of my divorce and second marriage! Besides, my husband is United Church of Christ!” When asked if she ever went to church with her husband, she again informed me, “He doesn’t go to his church either, because they didn’t approve of me!” She then, without prompting, drops a bomb shell on me, “Besides, we have you now (gives me a little, slobbery hug and kiss on the cheek)! You will be our pastor now!” When I asked her husband if I could contact someone for him to act as a spiritual advisor, he too affirmed his wife’s words, “No, we have not attended church in 40 years, and I am sure that you can take care of any religious needs we have!” It is worth noting here that while she could not remember the names of her children, she could quite accurately relate the painful history of a rather fractured faith background.

It would be easy sometimes to just “walk away” after a week of daily death, heartbreak, and mayhem. But someone must do this work… I believe Jesus would do this work… and I want so desperately to be Jesus to them. Sometimes I feel like I am close… but other times I know I am a million miles from the mark.What do I do for these ladies? What can I offer them? What does the ecclesia have to offer them? How can the gospel be presented to them this late in the situation? What form would the kerygma take, and what should it look like? In this context I do not stand at a podium, take a text, and pontificate about some aspect of the scripture, a format that anticipates an allotment of time in which to reflect, incorporate, and by which to become empowered. On the other hand, my actions become the kerygma for the patient, and therefore this lived sermon[2] must be a major consideration (and the result of) any research that is to be done on ministering to people at the time of death.

[1] Names of patients and their situation changed enough to protect the privacy and dignity of the patient and their families.[2] See Attachment #1 for sample sermon outline that is intended to be lived rather than spoken from a pulpit.

Attachment #1The Hand that Touched

Text - (Mark 1:40-42) (The Message)“A leper came to him, begging on his knees, "If you want to, you can cleanse me." Deeply moved, Jesus put out his hand, touched him, and said, "I want to. Be clean." Then and there the leprosy was gone, his skin smooth and healthy.”

Point#1The beggar’s situation seemed hopeless. Set apart in a dark place, alone, and certainly he was afraid. His hand reached out… (This will attempt to meet the patient where she/he is at this time – I see you! I hear you!).

Point#2Jesus recognized that the leper was after more than physical healing. If that were all there was to this story, then Jesus could have spoken the word from a distance and accomplished the same. No, Jesus recognized the outreached hand that said, “Can anybody love me just the way I am! I am so all alone in my pain, my disability, and my hopelessness!” So Jesus did what was important first – He touched the leper, He accepted the stigma of becoming a leper, and bridged the gap between heaven and hell! The healing of his body was secondary to the healing of his self image. (This will attempt to provide the patient with validation of life, faith, and meaning – I feel/touch you!)

Point#3How long had it been since he had been touched by anyone? Can you imagine with me for a moment how it must feel to not know the touch of man (or God)? Even a hand of hatred is better than total seclusion (an Eskimo proverb)! The gift of touch, regardless of the physical healing, created a feeling of wellness and wholeness in the man’s life. (This will hopefully infuse the patient with a sense of worth and accomplishment – I value you!)

Conclusion – The lived moment! * (Matthew 28:20b) “And remember, I am with you each and every day until the end of [your life]." (my paraphrase)

* It is my desire in the lived sermon to join the diseased body of humanity and the divine hand of God together!

Pastoral PrayerDear God we stand here in our weakness in need of your hand. We don’t pretend to understand the ‘why’ or any other of the deep questions of life. We do recognize the need of community… the need for someone to be here. Let my hands, the hands of the nurses and aides, and the hands of all who visit here be the hands of God. Let her community bring blessings, peace, and contentment in these hours of pain and passing. We ask all these things with our faith firmly in the mystery of your Son, Jesus Christ. As Jesus provided mediation between God and humanity – Let Kim’s community now mediate to her the endless love of the Master’s touch. Amen!